The proposed study will explore the medical decision process and the utility of advance directives in the nursing home. Specifically, it is an initial study which aims to: 1. Clarify the factors influencing end of life medical decisions in the nursing home environment. 2. Describe the current use of advance directives in medical decision making in the nursing home. Specifically, we will identify a subset of medical conditions in which advance directives are perceived to be needed. 3. Ascertain the most useful components and most needed portions of advance directives from the perspectives of both formal and informal caregivers. Although the Patient-Determination Act mandates offering the option of advance directives to all nursing home residents, it has been shown to be less than effective in actual implementation of directives. Both the actual preparation of advance directives and the execution of the plans are low, such that even when advance directives are prepared, they make little difference on the actual future care received. By understanding the process of medical care decision making in the nursing home, we hope to improve the format for execution of advance directives so that it will be more useful and effective in actual care received the nursing home residents. Additionally, this will be the first study of the medical decision making process in the nursing home.